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Home My WebLink AboutMPF CorpAPPLICATION FOR tRAt'NL'AYER'S LICENSE _a MANSFIELD, MA ) DATE: April 27, 1995 Name and/or Corporation: M.P.F. Corporation & Address: 30 Commercial Drive, Wrentham, Emergency 24 hour telephone", 08) Please attach the following: 1. valid Heavy Equipment operators License (copy); 2. Insurance Certificate (Town must be listed as additionally insured); 3. Performance Bond; 4. Three references who are familiar with your work with telephone numbers; 5. Application fee of $250.00. The undersigned hereby acknowledges receipt, understanding of the Drainlayer's Regulations, and that he/she has read the entire document. Signature: DPW Approval: �X�) l✓ • dj"- Date: S/�/� ISSUE DATE (MMMONY) PRODUCER MAZONSON INC. TWO CORPORATION WAY P.O. BOX 6071 PEABODY INSURED MPF CORP. FEDERICO ENTERPRI 30 COMMERCIAL DR. WRENTHAM, THIS CERTIFICATE IS ISSUED AS A CONFERS NO RIGHTS UPON THE C DOES NOT AMEND, EXTEND OR AL COMPANIES AFFORDING COVERAGE MA 01961-6071. COMPANY A LETTE R CRUM & FORSTER INS CO :................................ .............. .................................................................. ..............................................! LETTER Y ..B :.......................... ........... .............................................. ........ ................. ..... COMPANY C LETTER COMPANY MA 02093 LETTER D .......................... COMPANY E LETTER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTp: TYPE OF INSURANCE POLICY NUMBER DATE (MMND/YY) DATE (MMIDD/W) 111A1I8 GENERAL LIABILITY 503 516929 5 05/31/94 05/31/95 GENERAL AGGREGATE $2/.000, 000 }[ ;COMMERCIAL GENERAL LIABILITY i PRODUCTSCOMP/OP.AGG E2,_000, 000 : CLAIMS MADE X OCCUR.:. PERSONAL E ADV. INJURY $1 OOO OOO : OWNER'S ACONTTACTOR'S PROT. �. EACH. OCCURRENCE $1,000,.000 :........: FIRE DAMAGE (Any oSw) $ 5O OOO ........ / ... ......................... MED. EXPENSE (Any oM pawn) E 5,000 AUTOMOBILE LIABILITY 131 027336 1 05/31/94 05/31/95 ': GGMBINED SINGLE ........ ANY AUTO ;........: . OMIT :...................................... ......................... E1,000,000 ...................... ALL OWNED AUTOS .,_.._...: � :BODILY INJURY ; $ X ; SCHEDULED AUTOS : : (Per person) ..................................................................................... :........; :HIRER AUTOS BODILY INJURY S XNOWOWNED AUTOS lPer adtNnq GARAGE LIABILITY ........ _ :PROPERTY DAMAGE $ EXCESS LABILITY :........; :EACH OCCURRENCE .............................................._:........................................ :E UMBRELLA FORM AGGREGATE :E ....._.. OTHERTHAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS :.. ......................... EACH ACCIDENT E AND ................................................:........................................ DISEASE -POLICY LIMIT i $ EMPLOYERS' LU1BX1fY <................................................:........ ................................ DISEASE -EACH EMPLOYEE i $ OTHER ICNIPTION OF OPERATIONBM1OCATIONI)MEWCLESISPECW. ITEMS TOWN OF MANSFIELD, MA IS NAMED AS ADDTIONAL INSURED ON THE GENERAL LIABILITY &/OR AUTO POLICY WITH RESPECTS TO WORK PERFORMED BY M.P.F. CORP. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO TOWN OF MANSFIELD, MA MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 50 WEST STREET LIABILITY OF ANY KIND UP COMPAN , AGENTS OR REPRESENTATIVES. MANSFIELD, MA 02048 AUTHORED REPRESENTATI VI��` R. Bruce Mac ugal SJ B ISSUE DATE (MMDD" R""m' 04 /11/95 MC WALTER INS AGENCY INC 178 GREAT RD ACTON MA 01720 INSURED MPF CORP. 30 COMMERCIAL DR. WRENTHAM, MA 02093 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COMPANY A LETTER COMPANY B LETTER COMPANY C LETTER ....................... COMPANY D LETTER ........................ COMPANY E LETTER COMPANIES AFFORDING COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .. .......... ........................................... _..._.._................................._...................................._..................... ..,......_............................. ....... ._......................................................_._......... TYPE OF INSURANCE POLICY NUMBER POLICYPDATE M%MiDD EXPIRATION DATE MM/DD ( /YY) GENERAL LIABILITY : GENERAL AGGREGATE S .. ....................... ......................... ;COMMERCIAL GENERAL LIABILITY PRODUCTS-0OMP/OP AGG. S ..................... .......... CLAIMS MADE, OCCUR. PERSONAL & ADV. INJURY . $ . .......... ...... ..................... . :OWNER'S & CONTRACTORS PROT.: EACH OCCURRENCE : a ........:..................................................... :FIRE DAMAGE (Any one fire) .$ :............................................. ..:.................................... MED. EXPENSE (Airy one pereoo) ; $ AUTOMOBILE LIABILITY ......... COMBINED SINGLE : ANY AUTO : LIMIT $ .:....... ALL OWNED AUTOS :.................................... ............................ .................... . BODILY INJURY : SCHEDULED AUTOS - : (Per pemon) S : HIRED AUTOS ',. ........' :............................................................................. : BODILY INJURY ... o.S i NON OWNED AUTOS ? (Per mldenq :._.....i GARAGE LIABILITY .............................._ _.........i.................................... PROPERTY DAMAGE E EXCESS LIABILITY :....... EACH OCCURRENCE $ < UMBRELLA FORM :.,....._: ............................. .................. :......... .................... ....... AGGREGATE $ OTHER THAN UMBRELLA FORM _ O WORKER'S COMPENSATION WCP0005189 09/29/94 D9/29/95 X, STATUTORY LIMITS '_'. .................................................................... AND EACH ACCIDENT S 100,.000 ....... .. ... EMPLOYERS' LIABILITY .DISEASE —POLICY LIMIT $ 500TQQQ DISEASE—EACHEMPLOYEE :S 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATLONSNEHICLES/BPECULL ITEMS CERTIFICATE HQLDER:: ;CANQELLdTIQN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO TOWN OF MANSFIELD, MA ;'! MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE E� LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 50 WEST STREET LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. MANSFIELD, MA 02048 AUTHORED REPRESENTATNE ANNIE OGDEN( /% n c1-1 (( �' SJ B